We always here that those with lymphedema should not partiiapte in high impact exercises and that they are bad for us. Ever wonder exactly why?

Here is a question and answer on the subject that I recently had on another site.

Also, I have included information on possible hazards and injuies from high impact exercises. Any of the injuries can complicate your lymphedema, so consideration must be taken to remain safe. I absolutely believe in keeping as fit as possible and in exercise. If you have lymphedema work with your thereapist to design a safe and effective exercise program specifically designed for your needs and situation.

................

12/15/04

Author: Anonymous

Subject: Strenous exercise - High Impact Exercise

Pat, in message # 1318 you told me that overstraining my leg can worsen the lymphedema. Why? If exercise is good, what does heavy exercise do to worsen the situation? I would have thought that strenuous exercise would cause the limb to pump more blood and increase circulation. Also, I do some skipping with a skipping rope. Why is "high impact" exercises not good for you? Again, I'm thinking exercise, which increases circulation, should be good. I understand that blood circulation is not the same as lymp circulation (two different systems), however as I understand it, the lymp system is stimulated by muscle movement (even through chest expansion and contraction while breathing). Should I switch to one of those small trampolins or is skipping not considered "high impact"? Are they correct when they say that lymphedema can simply transfer from one limb to another? I thought mine was as a result of a sports injury (my foot swelled after a sprain and never went down and my calf also swelled and never went down). Thanks.

Response:

12/16/04

Author: Pat O'Connor

Subject: Strenous exercise - High Impact Exercise

Hi Anonymous - Remember though you have two circulatory systems at work in the process you are describing. With strenous exercise there is sudden surge in the need for oxegon and nutrients by the muscles and body limb being worked. It is the cardiovascular system that rushes to deliver extra amounts of blood and nutrients to the limb(s) involved. Part of this blood pool goes into the milieu (invironment) of the individuals cells. After its job of providing nutrients and oxegon is done, the wastes (lymph fluid) is supposed to be removed by the lymphatic system.

Of course with lymphedema, this system is already impaired and cannot even handle the usual amount of interstitial fluid. It is even more overwhelmed by the sudden rush of increased fluid and is unable to respond as it should - so that fluid just stays there. One other process might happen depending on the type of strenous exercise, severity of the impact of the exercise and that is you might trigger even a mild inflammatory response (body's response to trauma) - in this process even more fluid is rushed into an area as the body tries to protect and heal it. Its this combination which makes strenous exercise and high impact exercise not good for lymphedema. In low impact exercise you have neither of these body responses. Some, like the swimming actually acts as a "massage" therapy and can help the body remove fluid as it gently flows over the limbs. Hope this helps!! Keep fit though and don't let lymphedema keep you from not exercising - just make acommodations

Pat O'Connor

................

WHAT ARE THE HAZARDS OF EXERCISE?

Effect of Strenuous Exercise on the Heart

An estimated 1.5 million heart attacks occur every year. Of these, 75,000, or about 5%, occur after heavy exertion, leading to 25,000 deaths. The great majority of these heart events occur in high-risk individuals. For example, for the average non-smoking, non-diabetic, 50-year old man, the risk for a heart attack during strenuous exercise is only one in one million. In addition, the risk radically declines for those who get in shape gradually and stay fit through regular activity. [For detailed information see Box Heart Attack and Sudden Death from Strenuous Exercise.]

Injuries from High Impact Exercise

Competitive running or high-impact aerobics pose a high risk for a number of injuries in bones and muscle. High-impact exercise can also damage the inner ear, causing dizziness, ringing in the ear, motion sickness, or loss of high-frequency hearing. The effect of high-impact exercise on the back is not entirely clear. Some research suggests that over time, it may increase the risk for degenerative disc disease. A survey of people who played tennis, however, found no increased risk for low back pain or sciatica.

Some research further suggests that in people unused to exercise, intense activity increases production of harmful particles in the body called oxygen free radicals. These unstable particles bind to other molecules and injure muscle tissue. Muscle pain in this case is delayed for 24 to 48 hours after exercise.

The following are people at higher than average risk for high-impact injuries:

About half of people at any age who participate in competitive running or high impact aerobics experience minor injuries at least once a year. Young, intensely competitive athletes may be at risk for permanent injury. Studies are conflicting over whether intensive high impact sports in younger people cause long-term degenerative joint disease.

As more older people start exercising, there has also been a risk for injuries. Between 1990 and 1996, injuries from active sports increased by 54% in people age 65 and older.

Women are far more likely than men to suffer knee injuries. Urinary incontinence also affects many female athletes who engage in high-impact exercise.

Tennis players are at high risk for injuries from repetitive force on the shoulder joint.

Preventing High Impact Injuries. Even young people are at risk for injury form high-impact exercise. The following may be helpful for preventing injury:

Wear shock-absorbing footwear with weight-dampening inserts.

Combine weight lifting with jumping exercises. This may prevent injury by strengthening hamstrings and improving coordination.

Vary training and alternate easy and harder workouts.

Be careful to warm up, cool down, and stretch. Flexibility is the key to preventing many muscle strains.

Take days off now and then. The risk of injury increases when athletes train more than five times a week.

Because of the association between high-impact exercises and oxidation, some experts suggest that eating foods rich in antioxidants, such as vitamins A, C, and E, may be worth trying. Such foods include many fresh fruits and vegetables, and are certainly recommended in any case.

Treating Minor Injuries. Most mild or moderate injuries respond well to a simple, four-step treatment: rest, ice, compression, and elevation (RICE). This regime works well for both spot injuries and chronic problems. Ice packs, which minimize inflammation and pain, can help acute injuries and can be useful for the first few hours after a chronically injured area is exercised. Heat, ultrasound, whirlpool, and massage may speed healing if applied a day or two after the initial injury or for warm-up before another workout session.

Improper Mechanics and Hazardous Effects on the Back and Shoulders
Incorrect movements can literally cause mechanical problems in the muscles. They are usually the result of improper exercise instruction and inattention. As examples, a single jerky golf swing or incorrect use of exercise equipment (especially free weights, nautilus, and rowing machines) can cause serious back injuries.

Between 30% and 70% of cyclists experience low back pain. (One 1999 study reported that 70% of cyclists reported improvement simply by adjusting the angle of the bicycle seat.)

Dehydration

Everyone should drink lots of fluid during intense exercise. Thirst is often a poor indicator of dehydration in people who exercise, particularly older people, and they often underestimate the amount of fluid they need. During a tough workout in a hot environment, the body can lose two liters of fluid per hour through sweat. Anyone who exercises intensively should take the following precautions:

Drink six to eight ounces of fluid about 15 minutes before a workout, and then pause regularly during exercise for more.

Water is the best choice for replenishing body fluids. Glucose-sodium-potassium solutions, the so-called "sports drinks," that promise instant energy are apparently no better than water at improving endurance during prolonged intense running. Studies on two of these drinks (Endurox, Sports) reported no benefit from their use.

Caffeinated beverages like coffee and soft drinks give short bursts of energy but can actually reduce fluid. According to one study, caffeine before a workout temporarily raises blood pressure and reduces blood flow to inactive limbs.

Overheating, or hyperthermia, can be a problem with strenuous exercise or when working out in hot weather. Overheating can cause mild to life-threatening conditions. Heat exhaustion, a moderate form of hyperthermia, is characterized by the following symptoms:
Lightheadedness, nausea, headache, hyperventilation, fatigue, and loss of concentration.

A high temperature (above 103° F), possibly accompanied by complaints of chills and clammy skin.

Individuals should rest in a cool, dry place, drink plenty of fluids, and bring down their body temperature with ice packs pressed against the skin.

Heatstroke.

Heatstroke is the most dangerous complication of hyperthermia. The victim may suddenly cease sweating, after which symptoms such as altered consciousness, seizures, and even coma, may quickly follow. Heat stroke is a medical emergency and requires immediate cooling of the victim in an ice-water bath or with ice packs. One study suggests that risk for serious complications from exercising in high temperatures may persist as late as the following day, even if the weather has cooled down.
Frostbite and Hypothermia

Precautions also need to be taken in cold weather. When exercising in winter, dress in layers, including gloves and socks, which create insulated air pockets that trap heat. In cold weather, wear shoes with less ventilation than those worn in the summer. Fingers, toes, ears, and nose are most susceptible to frostbite. From stinging or aching, frostbite progresses to numbness. Fingers and toes may become white. Soaking the extremities in warm water can help, but only once there is no risk of refreezing, since a second bout of frostbite after thawing can accelerate tissue damage. Hypothermia can be life threatening and can occur even after prolonged exposure to temperatures that are above freezing. The condition is characterized by extreme fatigue, mental confusion, apathy, and a lack of coordination. The victim should be warmed as soon as possible with blankets, body heat, and warm fluids.

Muscle strength declines as people age, but studies report that when people exercise they are stronger and leaner than others in their age group.

Effects on Osteoarthritis

One study on patients with osteoarthritis compared one group who embarked on an aerobic and resistance exercise program with another that received patient education only. The exercising group developed less disability and pain and showed a better ability to perform physical tasks.

Although strong evidence for the benefits of exercise on osteoarthritis is lacking, there are some reasons to believe that arthritis can be improved with activity:

Low-impact aerobics help stabilize and support the joints and may even reduce inflammation in some joints. Cycling and walking are beneficial, and swimming or exercising in water is highly recommended for people with arthritis.

Strengthening exercises build muscle strength while burning fat and maintaining bone density. Some experts encourage patients to emphasize strengthening leg muscles as a first treatment step, even before using pain relievers. They fear that patients who rely on pain killing drugs may overuse knees, which do not have muscle tissue sufficiently strong enough to protect the joints from further damage.

Range-of-motion exercises increase the amount of movement in a joint and muscle. In general, they are stretching exercises. The best examples are Yoga and Tai Chi, which focus on flexibility, balance, proper breathing. They also lower stress levels, help to reduce blood pressure, and may even have beneficial effects on cholesterol levels.
Warning Note: Osteoarthritis patients should avoid high-impact sports such as jogging, tennis, and racquetball. They should strive for short but frequent exercise sessions guided by physical therapists or certified instructors.

Effects on Osteoporosis (Loss of Bone Density)

Benefits of Exercise on Osteoporosis. Exercise is very important for slowing the progression of bone loss (osteoporosis) and reducing the risk for falls that cause fractures. Older women are at highest risk for this disease but older men are also at risk. Children should begin exercising before adolescence, since bone mass increases during puberty and reaches its peak between ages 20 and 30. In fact, one study suggests that exercise may help increase bone mass in teenagers even more effectively than high calcium intake.

Specific exercises may be especially helpful for preserving or building bone or both:

Weight-bearing exercise are very beneficial for bones in people of all ages, even older people. This approach applies tension to muscle and bone, and the body responds to this stress by increasing bone density, in young adults by as much as 2% to 8% a year. Careful weight training can also be very beneficial for elderly people, particularly women. In addition to improving bone density, weight-bearing exercise reduces the risk for fractures by improving muscle strength and balance, thus helping to prevent falls.

Regular brisk long walks improve bone density and mobility. In older women, even moderate exercise (as little as an hour a week) helps reduce the risk for fracture. (Everyone who is in good health should aim for more, however.)

Exercises specifically targeted to strengthen the back can be beneficial in improving posture and may even reduce kyphosis (hunchback) in people with osteoporosis.

Low impact exercises that improve balance and strength, particularly yoga and tai chi, have been found to decrease the risk of falling; in one study tai chi reduced the risk by almost half.

Female Athlete Triad.

Some young female athletes who exercise very intensely and are subject to intense pressure to remain thin are at risk for the so-called female athlete triad. This triad of symptoms includes menstrual dysfunction, eating disorders, and osteoporosis. Eating disorders among young female athletes is estimated at 15% to 62%. Women at higher risk include ballet dangers, gymnasts, and divers. Continued intense exercise causes a stress response in which estrogen (the primary female hormone) declines. Estrogen loss then can lead to infertility and osteoporosis. Iron depletion and anemia may also be a problem in women who exercise frequently, even at moderate intensity. A physician should be consulted for any of these concerns.

Effect of Exercise on Back Pain

Effects of Sedentary Life. People who do not exercise regularly face an increased risk for low back pain, especially during times when they suddenly embark on stressful unaccustomed activity, such as shoveling, digging, or moving heavy items. Although no definitive studies have been done to prove the relationship between lack of exercise and low back pain, sedentary living is probably a primary nonmedical culprit contributing to this condition. Lack of exercise leads to the following conditions that may threaten the back:

Weak stomach muscles (can increase the strain on the back and can cause an abnormal tilt of the pelvis).

Weak back muscles (may increase the load on the spine and the risk for disc compression).

Obesity, associated with sedentary lifestyle (puts more weight on the spine and increases pressure on the vertebrae and discs). Studies report only a weak association between obesity and low back pain, however.

Benefits for Chronic Back Pain.

People in with sudden and severe back pain should not exercise. Specific exercises can be important during recovery, however, as well as for patients with chronic low back pain. In one study, for example, patients with back pain lasting for an average of 18 months were assigned eight one-hour exercise sessions over four weeks. They showed greater improvement in nearly every area, including reduced pain and increased capacity, compared to patients who did not exercise. In another study, patients who chose a passive route (massage and heat therapy) experienced slower recovery from pain than those who exercised (although after a year their conditions did not appear to differ much). Some studies suggest that the positive impact of exercise on low back pain does not depend on improving strength and flexibility but on changing the patients' attitudes toward their disability and pain.

Some exercise programs used for prevention or for chronic low back pain include the following:

Low Impact Aerobic Exercises. Low-impact aerobic exercises, such as swimming, bicycling, and walking, can strengthen muscles in the abdomen and back without over-straining the back. Programs that use strengthening exercises while swimming may be a particularly beneficial approach for many patients with back pain.

Lumbar Extension Strength Training. Exercises called lumbar extension strength training are proving to be effective. Generally, these exercises attempt to strengthen the abdomen, improve lower back mobility, strength, and endurance, and enhance flexibility in the hip and hamstring muscles and tendons at the back of the thigh.

Yoga, Tai Chi, and Chi Kung. These practices combine low-impact physical movements, breathing exercises, and meditation. Some studies suggest they may be very helpful in preventing recurrences of lower back pain.

Flexibility Exercises. Whether flexibility exercises alone offer any significant benefit is uncertain. One study suggested that any benefits derived from flexibility exercises are lost unless the exercise regimens are sustained.

Retraining Deep Muscles. Of interest are studies that are finding a link between low back pain and impaired motor control of deep muscles of the back and trunk. According to these studies, contraction exercises specifically designed to retrain these muscles may be effective for patients with both acute and chronic pain.

It is important for any person who has low back pain to have an exercise program guided by professionals who understand the limitations and special needs of back pain and who can address individual health conditions. One study indicated that patients who planned their own exercise did worse than those in physical therapy or physician-directed programs.

Hazardous Effects on the Back. On the other side of the coin, improper or excessive exercise is also an important risk factor for back pain.

A number of studies have indicated that regular, even moderate, exercise may reduce the risk of colon cancer and, in fact, any cancer related to obesity. A number of studies have also suggested that regular exercise, particularly if it is vigorous, reduces risks against breast cancer in women and prostate cancer in men.

Several studies are underway to measure the effect of exercise on patients who have been diagnosed with cancer. Even though preliminary, they already suggest that exercise has a positive physical, mental, and emotional effect. Exercise can improve physical strength, functional capacity, and the ability to battle the negative side effects of chemotherapy, including nausea and fatigue. More studies are warranted.

Effects on Infectious Illness

Although long-term effects of regular exercise are known to improve health, the immediate effect of exercise on the immune system is uncertain. In people who already have colds, exercise has no effect on the illness' severity or duration of the infection. However, people should avoid strenuous physical activity when they have high fevers or evidence of viral illness. High-intensity or endurance exercises appear to suppress the immune system while they are being performed. Some highly trained athletes, for instance, report being susceptible to colds after strenuous events.

Effects on the Gastrointestinal Tract

Endurance athletes often report gastrointestinal distress, such as bloating, diarrhea, and gas, even at rest. Experts suggest, however, that moderate regular exercise, might reduce the risk for some intestinal disorders, including ulcers, irritable bowel syndrome, indigestion, and diverticulosis. For example, in one 2000 study, exercise was associated with a lower risk for ulcers in men (although not in women.) Older people who exercise moderately may have a lower risk for severe gastrointestinal bleeding.

Effects on Neurologic Diseases and Mental Decline

A 2001 study reported that older people who regularly exercised had lower rates of mental deterioration, Alzheimer's, and dementia of any type. Aerobic exercise is linked with improved mental vigor, in all people, including reaction time, acuity, and math skills. Exercising may even enhance creativity and imagination. According to one study, older people who are physically fit respond to mental challenges just as quickly as unfit young adults. Another study found that walking regularly protects women from mental decline, and in fact, the more they walked per week, the more protection they enjoyed. (Stretching and weight training appear to have no such effects.)

People with existing neurologic diseases, such as multiple sclerosis, Parkinson's disease, and Alzheimer's disease, should be encouraged to exercise. Specialized exercise programs that improve mobility are particularly valuable for Parkinson's patients. Patients with neurological disorders who exercise experience less spasticity as well as reduction in, and even reversal of, muscle atrophy. In addition, the psychological benefits of exercise are extremely important in managing these disorders. Exercise machines, aquatic exercises, and walking are particularly useful.

Effects on Emotional Disorders

Although there is little strong evidence that exercise can help manage depression, a number of studies have suggested benefits.

The following are some examples:

A 2000 study reported that 30 minutes of brisk exercise three times a week may be just as effective as medication in relieving the symptoms of mild to moderate depression and reduces the risk of relapse.

A 1999 study on exercise in the elderly reported that after 26 weeks, exercise was as effective as antidepressants. (Antidepressants relieved depression earlier, however.)

One study found that teenagers who were active in sports have a greater sense of well being than their sedentary peers; the more vigorously they exercised, the better their emotional health.

Specific exercises may be particularly beneficial:

Aerobics. Either brief periods of intense training or prolonged aerobic workouts can raise chemicals in the brain, such as endorphins, adrenaline, serotonin, and dopamine, that produce the so-called runner's high. And, of course, weight loss and increased muscle tone can boost self-esteem.

Yoga. Yoga practice, which involves rhythmic stretching movements and breathing have been found to positively affect mood and may have clinical potential as a technique for improving and stabilizing mood. One study, in fact, suggested that men actually may have better results with yoga than with aerobic exercise. In the study men experienced significantly lower levels of tension, fatigue, and anger after yoga than after swimming. (Yoga and swimming tended to produce equal benefits in women.)

Effect of Exercise on Pregnancy

Healthy women with normal pregnancies should exercise at least three times a week, being careful to warm up, cool down, and drink plenty of liquids. Many prenatal calisthenics programs are available.

Experts generally recommend the following precautions for pregnant women who exercise:

Fit women who have exercised regularly before pregnancy may work out intensely as long as the physician approves and no discomfort occurs.

As a rule, for previously sedentary low-risk expectant mothers, the pulse rate should not exceed 70% to 75% of the maximum heart rate or more than 150 beats per minute. (In one study, such women exercised to 150 to 156 beats per minute three times a week without any harmful effects, but any woman should check with their physician before embarking on such a program.)

According to one study, vigorous exercise may improve the chances for a timely delivery. All pregnant women, however, should avoid high-impact, jerky, and jarring exercises, such as aerobic dancing, which can weaken the pelvic floor muscles that support the uterus.

During exercise, women should monitor their temperature to avoid overheating, a side effect that can damage the fetus. (No pregnant women should use hot tubs or steam baths, which can cause fetal damage and miscarriage.)

The following are specific exercises that may benefit the pregnant woman: Swimming and water aerobics may be the best option for most pregnant women. Swimming has special benefits for those with fluid build-up. Water exercises involve no impact, overheating is unlikely, and swimming face down promotes optimum blood flow to the uterus.

Performing yoga exercises under the guidance of informed instructors can be very helpful.

Walking is also highly beneficial.

To strengthen pelvic muscles, women should perform Kegel exercises at least six times a day. This involves contracting the muscles around the vagina and urethra for three seconds 12 to 15 times in a row.